Payment Accuracy COB Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Analyze and evaluate claims, member, and group data to pinpoint recoverable claims for Cotiviti and its clients.

• Determine the correct order of liability for clients’ members in Coordination of Benefits scenarios.

• Enter precise claim recovery details into Cotiviti's proprietary software tools.

• Provide assistance with inquiries throughout the claim recovery procedure.

• Utilize CMS and NAIC guidelines to ascertain the order of liability.

• Conduct member investigations using the Recovery Management System (RMS), COB Tracker, and specific client systems.

• Generate accurate documentation in Cotiviti and/or client audit tools.

• Achieve or surpass production and quality benchmarks under direct supervision.

• Prepare and assess responses to client disputes.

• Categorize errors and overpayments for healthcare clients and address related issues.

• Identify opportunities for continuous improvement in reporting and research methodologies.

• Adhere to Cotiviti policies, procedures, HIPAA regulations, and external compliance requirements.

• Fulfill performance-plan responsibilities, special assignments, and designated tasks.

⛳️ Requirements

• A High School Diploma is required.

• A Bachelor’s degree is preferred.

• At least 1 year of relevant healthcare experience is necessary.

• Experience in the healthcare industry, particularly knowledge of Coordination of Benefits, is preferred.

• Proficiency in computer applications, including Microsoft Office (Word, Excel, Outlook), is essential.

• Outstanding verbal and written communication skills.

• A passion for working with large datasets and diverse databases.

• Capability to work both independently and as part of a team.

• Skill in analyzing extensive data sets to identify trends, discrepancies, and anomalies.

• Exceptional attention to detail.

• Strong critical-thinking and problem-solving abilities.

• Capacity to make informed decisions based on data, regulations, and auditing standards.

• A solid understanding of auditing standards, regulations, and industry best practices.

• Ability to recognize issues that require further investigation.

• A dedicated and secure work area is mandatory.

• High-speed internet access/connectivity and appropriate office setup and maintenance must be provided.

• Able to perform duties with or without reasonable accommodation.

🏝️ Benefits

• Consideration for discretionary bonuses.

• Coverage under medical insurance plans.

• Coverage under dental insurance plans.

• Coverage under vision insurance plans.

• Disability insurance coverage.

• Life insurance coverage.

• Access to 401(k) savings plans.

• Paid family leave benefits.

• Nine paid holidays each year.

• 17-27 days of Paid Time Off (PTO) each year, determined by specific level and length of service.

• High-speed internet access/connectivity and office setup and maintenance are required for the role.